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Aetna Workers Compensation Field Case Manager RN in Blue Bell, Pennsylvania

Req ID: 67587BR

Job Description

Position description: The Workers Comp Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet the injured workers comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. By meeting with involved parties such as injured worker, treating physician, employer and other parties, the case manager will develop treatment plan and assist injured worker in following the treatment plan to progress towards recovery from work injury and return to work

.

Fundamental Components included but are not limited to:

  • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.

  • Implements and coordinates all case management activities relating to workers compensation cases across the continuum of care that can include consultant referrals, home visits, and provider visits.

  • Interacts with clients telephonically and in person. Will be required to meet with clients in their homes, work-sites, or physician s office to provide ongoing case management services.

  • Assesses and analyzes injured clients medical and/or vocational status; develops a plan of care to facilitate the client s appropriate condition management to optimize medical outcomes, aid timely return to work or optimal functioning.

  • Communicates with client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.

  • Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.

  • Provides educational and prevention information for best medical outcomes.

  • Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports.

  • Utilizes case management processes in compliance with regulatory and company policies and procedures.

  • Facilitates appropriate condition management, optimize medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.

  • Develops proactive course of action to address issues presented to enhance short/long term outcomes.

  • Monitors client progress toward desired outcomes through assessment and evaluation.

Qualifications Requirements and Preferences:

Required Skills/Experience:

  • 3+ years clinical practice experience

  • Registered Nurse with active state license in good standing in the state where job duties are performed

  • Ability to travel within a designated geographic area for in-person case management activities

  • Excellent analytical and problem solving skills

​- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications

  • Effective computer skills including navigating multiple systems and keyboarding

  • Associate's degree in Nursing

Preferred Skills/Experience:

  • Bilingual preferred

  • 3+ years of case management experience

  • Ability to work independently

  • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM)

  • Knowledge of laws and regulations governing delivery of rehabilitation services.

  • Effective communications, organizational, and interpersonal skills.

  • Job-specific technical knowledge (e.g., knowledge of workers compensation and disability industry for workers compensation case managers or case management)

  • Bachelor's and/or Master's degree in Nursing or related field

Licenses/Certifications:

Nursing - Certified Case Manager (CCM), Nursing - Registered Nurse (RN)

Functional Skills:

Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Occupational Health

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Required Skills:

General Business - Applying Reasoned Judgment, General Business - Communicating for Impact

Additional Job Information:

This is an ever-changing position where each day is different. Very fast paced and requires candidate to think on their feet and to problem solve. Home care background or orthopedics background helpful. Must be organized, good with technology, and have good computer skills.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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